Birth Control/Taking the pill correctly

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Expert: Julia Fout - 1/3/2013

QuestionHi there, Iíve been on the pill for about 4 years and have just changed to taking Marvelon. Up until now I have taken the pill without much thought because I have not had sex and was just taking it for heavy periods. However, I am getting married in a couple of weeks and I just wanted to ask a few questions about pill taking and preventing pregnancy, which Iím hoping you can help me with =)

At the moment, I time my periods for when is most convenient for me. For example I wonít take the last 2 pills in the packet and take the 7 day gap early or on the other hand I go over a couple of pills into the next pack before taking the 7 day gap. As well as this, I sometimes donít leave a full 7 day gap, sometimes Iíll take a 5 or 6 day gap so the period will end sooner. While this didnít matter when I wasnít sexually active now Iím about marry my fiancť, will these habits make the pill ineffective for preventing pregnancy?

Also, if I happen to miss a pill, I usually just ignore this and carry on until the end of the pack. What should I now do if this happens to prevent pregnancy?

I think I just need a little help understanding how the pill works to prevent me from becoming pregnant too early into our married life!
Thanks a lot
Alice

AnswerHi, A.

Great questions. Let me see if I can clarify things for you:

1. How the pill works:

As you probably know, when you're unmedicated your body spends the majority of the month preparing for the potential to become pregnant by maturing and releasing an egg and by building up a nice, nutrient rich lining in your uterus called the endometrium. When you don't get pregnant, that lining gets flushed out in the form of your period and the whole cycle starts over again.

When you're on birth control the synthetic hormones protect against pregnancy in three different ways. 1. You don't ovulate, 2. Your cervical mucus gets thicker and harder for sperm to get through, 3. Your endometrium doesn't build up as thickly.

When you get to your placebo week, you have what's called a "withdrawal bleed", which is when what little uterine lining you have gets released. Even if you have sex during the placebo week, the pregnancy risk is low due to the long half-life of bc pills (how long they stay in your system) and because if everything has worked correctly, there's no egg to fertilize.

I don't see anything glaringly wrong with the way you're managing your period now. Marvelon is a monophasic birth control which means every pill has the exact same dose of hormones in it, which means that if you take a few pills from end of one pack at the beginning of a new cycle, it doesn't change the amount of medicine you've ingested. If you ever switch to a birth control that delivers different levels of hormones at different times in the month, you would need to be more careful.

I do have some concerns, however, when it comes to preventing pregnancy. In order to have full coverage, you need roughly three weeks of uninterrupted pill-taking. Starting your gap too early (by more than one or two days) could mean that you would not be fully protected during the placebo week. And while I don't take issue with you shortening your period, never delay starting your new pack - by forgetting to fill the new Rx, for example - because that will compromise your protection. So,I don't think you're being dangerously risky, but you are adding a layer of complexity to the situation. I would recommend that if babies are truly a non-option, then for the majority of the time you should try to follow the prescribed schedule.

3. Missing pills:

As soon as you realize you've missed a pill, take it immediately. This might mean that you end up taking two pills in one day. If you're like me, taking two birth control pills close together can make you really nauseated. If you throw them up, obviously the pills wont work, so you may need to spread them out. If you miss two pills in a row, spread the missed pills over two days, so you would take a normal pill plus a skipped pill one day, and a normal pill plus a skipped pill the day after. If this happens you need to use a back up method of birth control for at least seven days. Don't take more than two pills per day.

Julia Fout

Expertise

I can answer questions pertaining to how to choose and acquire contraception, how to talk to parents, doctors and partners about birth control, emergency contraception, missed periods, breakthrough bleeding,and how to use all methods correctly.

Experience

I am working towards my Masters of Public Health with a concentration in Health Behaviors and Health Education. The advice I provide is based on the most recent scholarly research in the areas of health, adolescent development, sex education and the promotion of healthful sexual behaviors. I want to be able to provide teens with relevant, practical, fact-based information so they're well equipped to navigate tough choices and confusing situations.

OrganizationsECU, the Brody School of Medicine, Department of Public Health